Your group will submit Group Project Final Report consisting of a total of 25-30 pages, due on March 31st, 2009, at the beginning of the class, worth 15% of your final grade.
The following should be included in the Group Project Final Report:
Group Project Interim Report (not including the preliminary recommendations)
Updated Table of contents;
Part 3: Recommendations
Based on the situation analysis and SWOT analysis done in the Group Project Interim Report, outline at least 4 recommendations you would make for the organization (with regard to the system you have discussed) or the system;
Back up your recommendations with your analysis as well as the secondary sources (i.e. justify and discuss your recommendations);
Discuss how this case/technology may impact on your own lives and/or careers;
Final project conclusions that sum up your findings and arguments
References
DANS SLIDES:
Strengths: -GIS systems (geographical information systems) are systematic software that captures, analyzes, and manages data according to specific locations. GIS systems thus have the tools, which allow users to generate and analyze ‘spatial’ information, edit data and maps, and thereby present the results. Specifically, when relating these tools to ambulances and other such emergency uses, it provides advantages. Emergency planners can utilize these tools to calculate quick response times in the event of natural disasters and other emergency events. -Why use GIS? Its simple, GIS systems can rearrange and integrate data with a spatial component meaning that with the information provided, a visual will be there to support the provided data. “For example, it is possible for you to combine the location of the Ambulance in relation to people’s homes, located by the address derived from the databases. GIS systems map this data, giving the emergency dispatchers a visual tool to plan the best routes for emergency mobiles. This ultimately saves time and lives.” Weaknesses: -Geographers have recognized since long time ago, that location-specific attributes were vital and they influence the incidence. Geographers have notified that time and space are critical to the human condition, but why has public health taken so long to do the same? With the introduction of GIS, it is revolutionizing geography and they have the same potential within public health. The potential of these systems effectively puts into the hands of epidemiologists and prevention specialists the power to understand and manipulate space and place (Harries and Daub). However the consequence of this is that the public health professionals must learn to “think” geographically. As much as it sounds easy, this knowledge is not easily acquired. -EMS has shifted from its traditional role of emergency transport and inter-facility transfers for emergency and non-urgent circumstances. Due to “concentrating expensive surgical/trauma and other specialty procedures in large urban or regional hospitals, the ‘aging’ of Canada’s population, the shortage of rural physicians, and the reality that few family physicians provide evening and weekend medical care for their patients,” (EMS Cheifs of Canada) EMS is further more important to Canadian residents. With these trends, Canadians further rely on EMS’s health care delivery.
Recommendations: Weakness -GIS systems are an important tool for health professionals because it acts as a window into the world of geography. These systems capture and present data and displays geographic information, which ranges from spatial information and it also provides where incidents are occurring. By ensuring that health professionals are fully trained to operate GIS systems and to present it, it enables them to send out routes and locations as fast as possible and as efficiently as possible. All health care centres and health professionals should fully train their GIS operators with all required knowledge and everything that needs to be learned so that they do not run into any dilemmas when an emergency arises. -Some of the risks that come up to mind are that these GIS manufacturers might charge a great deal in teaching courses for health professionals. This might result in health professionals just to negate the process of learning from “professionals” and trying to learn how to operate the GIS systems themselves.
-GIS systems range in its capabilities and its costs. Some GIS systems are available at no costs, and some are very expensive. Some of the GIS softwares cost hundreds and thousands of dollars and are difficult to use. Basic spatial analysis programs can cost between $200 to $2000 (Harries and Daub). GIS systems are vital tools to save lives and assist in emergencies that occur. However, it is reasonable that many of these systems are expensive to maintain because they are so high-tech. -GRASS GIS (Geographic Resources Analysis Support System) is a free, open source geographical information system (GIS) capable of handling raster, topological vector, image processing, and graphic data. GRASS GIS systems is beneficial to many health professionals because it can be used on multiple platforms which include Mac OS X, Microsoft Windows and Linux. We suggest that all of North American governments and cities utilize this GRASS system because it is free and have many benefits. Health professionals don’t have to worry about having to purchase expensive systems that do the same things that GRASS offers. Another advantage of GRASS is that it is specially designed as an environment in which tools that perform specific computations. Unlike other GIS softwares, the user is presented with a UNIX shell containing a modified environment that supports GRASS commands (GRASS GIS
For opportunities and threats and two recommendations pertaining to them, please see
Strengths: GIS systems (geographical information systems) are systematic software that captures, analyzes, and manages data according to specific locations. GIS systems thus have the tools, which allow users to generate and analyze ‘spatial’ information, edit data and maps, and thereby present the results. Specifically, when relating these tools to ambulances and other such emergency uses, it provides advantages. Emergency planners can utilize these tools to calculate quick response times in the event of natural disasters and other emergency events.
This SWOT analysis will focus on GIS systems related with Ambulances and other emergency events. The reason that GIS systems prove to be so meaningful and useful for ‘Emergency ambulances’ are because the information at hand can be constantly accessed, transferred, rearranged, processed, and displayed using numerous applications. Emergency uses in Canada often use custom soft wares such as “GRASS” which is a more specialized product that is more efficient advanced. (What is Grass? Geographic Resources Analysis Support System, commonly referred to as GRASS GIS, is a Geographic Information System (GIS) used for data management, image processing, graphics production, spatial modeling, and visualization of many types of data. It is Free (Libre) Software/Open Source released under GNU General Public License (GPL)) (Grass GIS).
GIS data previously was based on gigantic computers to maintain data and records (limited soft wares). Technology progressed and the increase of internet access grew the demand for GIS. Geographical features are expressed as vector images and different types of geometry, which are by points-lines-and polygons, represent these features.
Why use GIS? Its simple, GIS systems can rearrange and integrate data with a spatial component meaning that with the information provided, a visual will be there to support the provided data. “For example, it is possible for you to combine the location of the Ambulance in relation to people’s homes, located by the address derived from the databases. GIS systems map this data, giving the emergency dispatchers a visual tool to plan the best routes for emergency mobiles. This ultimately saves time and lives.” (Why Use Gis).
Relating GIS systems used in Emergency vehicles can be related to the study of Business Intelligence in Lecture 3 of Class 225. Business Intelligence is the knowledge about your customers, competitors, business partners, competitors, and internal operations (Evans). GIS systems in ambulances would correlate with BI Systems because it is an IT application that supports the business intelligence function from within. The objective of BI systems is to improve timeliness and quality for decision-making (Evans). Utilizing GIS systems allow users to generate and analyze ‘spatial’ information, edit data and maps, and thereby present the results. Specifically, when relating these tools to ambulances and other such emergency uses, it provides advantages. Emergency planners can utilize these tools to calculate quick response times in the event of natural disasters and other emergency events. Therefore, Emergency planners will have direct advantage in a case of crisis over anyone else.
Weaknesses:
When thinking of GIS systems, people might think that it is a wonderful piece of technology; and it is. However there are some downfalls to this specially designed software. In the early days, when any kind of epidemic broke out, there was no available therapy, or mode of quick transportation or any responsible agent (EMS). Location was key and the environments around the location.
Geographers have recognized since long time ago, that location-specific attributes were vital and they influence the incidence. Geographers have notified that time and space are critical to the human condition, but why has public health taken so long to do the same? With the introduction of GIS, it is revolutionizing geography and they have the same potential within public health. The potential of these systems effectively puts into the hands of epidemiologists and prevention specialists the power to understand and manipulate space and place (Harries and Daub). However the consequence of this is that the public health professionals must learn to “think” geographically. As much as it sounds easy, this knowledge is not easily acquired.
There are some concerns with geography; the characterization of places, understanding of man to land relationships, accounting for spatial distributions, and the differentiation of areas and the formation of regions (Harries and Daub). Geographic analyses have one of two aims which are; to account for spatial variation and to integrate all of the variation at a location so as to explain or characterize a place or region.
GIS is an important tool for health professionals because it acts as an access window into world of geography. However, GIS software ranges in its costs and capabilities. Some programs have been available at no cost, where as some of the other GIS softwares cost hundreds and thousands of dollars and are difficult to use. Basic spatial analysis programs can cost between $200 to $2000 (Harries and Daub)..
Other then the fact that maintaining GIS systems are expensive; there are three required elements for the applications of GIS to public health. The first element is that a specific GIS software program must be acquired. These programs are available in most of the Asian countries and European countries. The second element is that computer readable files must be acquired. These readable files are similar to hard copy maps showing various jurisdictional boundaries. Boundary files are unique to the GIS’s study area (Harries and Daub). For instance, in the US, one might acquire files for zip-codes and state boundaries; In England, they have their own postal zones. So in a general sense, the boundary files must be digitally compatible with the specific GIS software product. Finally, the third element requires that the GIS systems obtain geographically referenced attribute data; which is all the data pertaining to the demographics, population and "cases" to be mapped (Harries and Daub).
Opportunities
In examining the opportunities of the EMS system, we can look at it from a political, economical, environmental, social, and technological perspective. Technologically speaking, greater technological advances lead to higher efficiency. Higher efficiency includes a shorter route for emergency services, this could save staff and patient time and gas. Saved time and gas provide for a more economical environment. Socially speaking, better health care means higher social responsibility for the greater population. The opportunities listed are just examples of the benefits EMS creates. Further more opportunities are explored below.
Hospitals today are not only judged by indicators of patients’ health and recovery. “The modern hospital is a socio-technical organization.” (Dave 238) Aside from the end result, hospitals are also being judged and criticized for the process and delivery of health care. Since the GIS system has proven to increase response times and bring patients to the nearest hospital on the fastest route, it is safe to say that the quality of service delivery has improved. Thus, if a quality assurance analysis were to be made for EMS Emergency Ambulance or for the general health care system, the quality has improved in terms of service delivery for customer care.
Due to the sophistication of GIS, not only is the EMS prepared to get to point A to point B, surveillance of disease-prone communities can now be implemented. “Medical surveillance (or biosurveillance) systems look at the health and disease status of a population.” (Busko) The GIS will be able to detect and flag existing clusters of diseases and symptoms in any certain area. If the clusters are happening more than expected, safety measures can be taken into account. The technology of GIS is able to go beyond our daily health care emergency delivery by surveying the whole community for dangers.
Since GIS systems utilize spatial data, it is environmental friendly. Unlike activities that require natural resources, GIS systems use spatial data. And unlike other resources, “spatial data do not suffer any wear and tear from repeated use.” (Boulous)
In contrast, repeated use of spatial data would benefit the staff (or user). Increased use would increase the possibilities for improving the quality of spatial data and collections. The more we learn how to use the system and the more feedback we provide for GIS creators, the higher the future quality of it. With the use of spatial data, we do not have to worry about consuming the environment’s limited resources. Instead, we can happily go about using spatial data because we know it may be a good cause for the future creations of GIS.
EMS has shifted from its traditional role of emergency transport and inter-facility transfers for emergency and non-urgent circumstances. Due to “concentrating expensive surgical/trauma and other specialty procedures in large urban or regional hospitals, the ‘aging’ of Canada’s population, the shortage of rural physicians, and the reality that few family physicians provide evening and weekend medical care for their patients,” (EMS Cheifs of Canada) EMS is further more important to Canadian residents. With these trends, Canadians further rely on EMS’s health care delivery. The reliance provides a sense of security and safety to those in need. With increased importance to the community, EMS goes beyond its traditional role of health delivery. For example, Long and Brier Islands of Nova Scotia “lack immediate access to doctors and nurses, so EMS has assumed non-traditional roles in the realm of primary health care, such as administering flu vaccinations on the islands.” With ever more importance to society, EMS is pursuing in a role expansion to support Canada’s increased health demands.
Threats
Emergency care and access should be well informed to the public. It is the EMS’s duty to educate the public. “Efforts at education are directed towards the importance of calling for help early.” (Dave 247) Although response and put times are more efficent with the GIS, it should be made clear that calling for help early is vital. In the United States, a “911 Telephone Triage System is in place.” (Dave 247) In addition to highlighting the importance of calling EMS early, CPR and BLS should also be taught to the community. To prevent accident injuries and fatalities, the use of seatbelts in vehicles should be mandatory, drinking and driving should be prohibited, car seat placement should be directed for children, and the use of airbag and child safety should be implemented. It is up to the EMS to educate its citizens, but it is up to the citizens to learn and follow rules, regulations, and precautions. To further increase efficient use of EMS, a curriculum and local education is needed.
Since GIS utilizes the maps and images derived from satellitie systems, there is the question of privacy and censorship. The access GIS has intervenes and involves with everyone’s personal environment. “A number of these studies using the networking capabilities of GIS have been concerned with the concept of potential accessibility. Others, who have had access to spatially disaggregated data, have been concerned with (actual) revealed accessibility patterns of service utilization.” (Boulous) It is debatable whether this is ethical or not. Does efficiency equal less privacy? A public consent may be the solution to problems with privacy and censorship.
Although surveillance systems can detect disease and symptom clusters in communities, it is not fool-proof. “Surveillance systems must look for ‘important’ disease or syndromes and be able to detect changes from the baseline.” (Busko) For example, SARS symptoms may be detected as flu symptoms. The symptoms and diseases need to be clearly distinctive in severity and morality of other diseases in order for the surveilannce to identify it correctly. Therefore, false and ambiguous assumptions may be made about the detected diseases.
Federal funding and financial sponsors for health care systems have been restricted and the shaky economy does not make any positive promises for the future health care budget. “In an era of governmental fiscal restraint it is likely that federal funding for EMS activities will continue to decrease.” (NHTSA) This jeopardizes the availability of GIS across all provinces and states. When there is not enough financial resources, will the government restrict the areas where GIS will be implemented? It may not be fair to all citizens if there is not equal access to EMS technologies.
Federal funding has decreased and financial sponsors for health care systems have been restricted but yet, Canada is facing higher demands in the health sector as the senior population soars rapidly. EMS and paramedics focus on providing life support and emergency care to stabilize patients’ conditions as they rush to the nearest hospital. Demands for EMS services are anticipating a high demand because of demographic trends, such as a rapidly increasing senior population “Canada faces significant aging of its population as the proportion of seniors increase more rapidly than all other age groups. In 2001, one Canadian in eight was aged 65 years or over. By 2026, one Canadian in five will have reached age 65.” (Health Canada) With an increased demand and lowered funds, EMS needs to find a solution somehow to meet the community’s needs.
Health care delivery for EMS goes beyond simple automobile deliveries, EMS also employs the use of helicopters, satellites, and GIS. In saving the lives of patients, EMS staff also put themselves in danger on the road and in the air. “Dr. Ira Blumen, program and medical director of the University of Chicago Aeromedical Network, noted that the rate of fatalities per 100,000 air-ambulance employees over the past 10 years exceeds those of other dangerous professions such as deep-sea fishing or logging.” (EMS Daily News) It has become a concern that EMS staff and emergency patients’ lives are in danger while ironically striving for the opposite; saving lives. The irony brings us to wonder about the safety precautions that should be taken into account. Rules and regulations should be implemented to ensure the safety of the general public, including those of paramedics and EMTS. Saving lives should not cross lines with risking lives.
Recommendations Threat: Keeping the public informed.
According to the first threat listed, the supporting informed public is important in order for an EMS system to be effective. The EMS organization needs the support of the public that they are serving. To develop this relationship between the two, EMS needs to reach out to its citizens and communities venues such as neighbourhood associations, service groups, and participating citizens. It is a valuable relationship that will benefit the EMS organization’s reputation but more importantly, it will keep citizens well informed and supportive of what EMS provides and accommodates.
Reaching out to citizens may come in all sorts and forms. One way of public education is starting with children. Children are the ones who are more open and willing to learn. EMS staff and representatives may consider visiting schools with pamphlets, presentations, and activities that bring enthusiasm to the children. As an example, Canada’s fire and safety department utilize a mascot called, Elmer the Safety Elephant, to attract children. Elmer teaches the children to “stop, drop, and roll” when they catch on to fire. “The role of Elmer the Safety Elephant is to teach young children how to stay safe. From the day he first appeared over 50 years ago, he was an instant hit with kids. Over the years, his image has changed to maintain his positive impact on young children.” (Canada Safety Council) Elmer the elephant has been around for 50 years now and continues to be an asset of informing children all over the nation. Elmer’s 50 years of existence proves that it has been a success and the EMS organization should consider employing a similar strategy of education.
To educate the public children of EMS services, EMS may send representatives and staff to schools annually. A roadblock to this form of education may be acquiring the permission of school administrators and parents. A formal proposal will be needed to show the importance of safety acknowledgement. Since similar programs like Elmer the Safety Elephant has been implemented before, consent for another mascot should not be difficult. Although this may require time and extra-curricular costs for the organization, the expected result is worthy.
Thorough and interesting information must be communicated to the public. If information is not thorough, the whole process will fail to inform. If the information is not interesting, children will not engrave the information in their heads. Staff and representatives of EMS can share personal stories. Games and activities may be pursued in for children to get involved with the learning process. Following the examples of Elmer, the Elmer site provides children with coloring pages that can be printed out, activities, games, and quizzes. (Canada Safety Council) Therefore, a well thought-out educating process is required in order for it to be effective and useful.
The education of EMS’s services will provide a support and knowledge foundation for its services. A developed relationship with the community establishes a foundation of support that may come in handy when attempting to create new EMS stations, routing emergency response paths, or gathering additional funds for the future. A positive reputation is beneficial to the EMS for such factors but most importantly, educating the public for their own safety is vital. A well informed public will further increase medical efficiency, decrease respone times, and keep citizens secure. A curriculum and local education will create a more informed community. Threat: The fatal accidents and injuries of EMS helicopters
The goal for EMS staff is to help stabilize the situation of patients while transferring them to further professional help in hospitals in the shortest time frame possible. Advanced technology using satellites and GIS have enabled decreased response times and higher survival rates. However, these increased survival rates may only apply to the patients. “In January 2006, the NTSB issued a Special Investigation Report on EMS operations that involved the analysis of all EMS-related aviation accidents that occurred from January 2002 through January 2005. There were 55 accidents during this three-year window; they involved 41 helicopters and 14 airplanes, and killed 54 people and seriously injured 19.” (EMS Daily News) Planes and helicopters have been lost, lives have been taken away, and staff and patients have been hurt through the process of life-saving.
The irony of these accidents have been brought to the attention of the general public. Accidents occur but prevention and precautions help keep accident numbers to a minimal. “The Board concluded that 29 of the 55 accidents could have been prevented with corrective actions identified in the report.” (EMS Daily News) It is unfortunate that the lost lives could have been saved. It should be recommended that EMS operators follow a certain set of guidelines, rules, and regulations for patients’ safety, as well as their own. In response to these accidents, recommendations have been made already but there has yet to be legal rules made by policy makers.
If regulations and rules are followed, EMS staff would be able to conduct emergency deliveries in a more safely manner and arrive at the hospital “flawless.” “It recommended that the FAA require all EMS operators to comply with Part 135 operations specifications during the conduct of all flights with medical personnel on board; mandate that all EMS operators develop and implement flight risk evaluation programs; require EMS operators to use formalized dispatch and flight-following procedures that include up-to-date weather information and assistance in flight risk assessment decisions; and require EMS operators to install terrain awareness and warning systems (TAWS) on their aircraft.” (EMS Daily News) Further training should be required for EMS personnel. This may create more costs but will result in future benefits. Less planes and helicopters would be lost, more lives will be saved.
In addition to formulating legal rules and precautions to be taken into account, air ambulances should also streamline their patient acceptances. A typical flight at work usually involves a helicopter or plane and crewmembers who are paramedics and pilots. Also, “air-ambulance flights spend more time flying without patients than with them.” (EMS Daily News) Weighing out the costs and benefits, it seems almost unworthy to fork out so many risks and monetary costs for minor injuries. Canada’s paramedic training system, Ornge, faced a high number of accidents in injuries previously but has now gained international recognition. Ornge used the strategy of streamlining, which allowed them “to treat the entire province like a busy emergency room, where the sickest patients – whether an elderly woman who needs emergency heart surgery, or a 3-year-old whose face was slashed in a lawn mower accident – are transported first.” (Ogilvie) Streamlining forces EMS air ambulances to do only what’s crucial.
To streamline would mean to cut back on the transportation of non-urgent patients. The cost of this is a health care system that overlooks certain patients. Although this may put air-ambulances in a bad light, streamlining is actually saving lives by taking safety precautions. Therefore, streamlining should be implemented to take out the irony of what EMS strives for.
Weakness: Health Professionals Must be Aware of How to use GIS systems
The first weakness I have decided to target is that even though the potential of these systems effectively are in the hands of epidemiologists and prevention specialists the power to understand and manipulate space and place (Harries and Daub), the consequence of this is that the public health professionals must learn to “think” geographically. As much as it sounds easy, this knowledge is not easily acquired. This means that health professionals must know everything in terms of geography; they must be familiar with the characterization of places, understanding of man to land relationships, accounting for spatial distributions, and the differentiation of areas and the formation of regions.
The reason why we targeted this weakness is because it is critical for health professionals to be able to use and utilize GIS systems to ensure fast and efficient routes and times when sending out EMS (Emergency Medical Services) and EMV’s (Emergency Medical Vehicles). GIS systems are an important tool for health professionals because it acts as a window into the world of geography. These systems capture and present data and displays geographic information, which ranges from spatial information and it also provides where incidents are occurring. By ensuring that health professionals are fully trained to operate GIS systems and to present it, it enables them to send out routes and locations as fast as possible and as efficiently as possible. All health care centres and health professionals should fully train their GIS operators with all required knowledge and everything that needs to be learned so that they do not run into any dilemmas when an emergency arises.
mPower Innovations have decided to create GIS systems for American governments which are made easy and easily affordable. Many city governments are leaning towards mPower and are taking control of their mapping applications and data (mPower Webcast). This company offers webcast presentations on certain days and allow people to register and attend these events to learn and how to use their softwares. If all of the GIS manufacturers were to use this technique in the world and teach health professionals and EMS operators, they would be able to think geographically and attend to emergencies most efficiently.
Some of the risks that come up to mind are that these GIS manufacturers might charge a great deal in teaching courses for health professionals. This might result in health professionals just to negate the process of learning from “professionals” and trying to learn how to operate the GIS systems themselves. The recommendation chosen has been incorporated before as mentioned above. mPower Innovations offer webcast presentations but we are unsure if they offer open classes or private classes that cost money.
Weakness: Using GRASS GIS systems which are Cheap and Useful
The second recommendation will also be based on another weakness. GIS systems range in its capabilities and its costs. Some GIS systems are available at no costs, and some are very expensive. Some of the GIS softwares cost hundreds and thousands of dollars and are difficult to use. Basic spatial analysis programs can cost between $200 to $2000 (Harries and Daub). GIS systems are vital tools to save lives and assist in emergencies that occur. However, it is reasonable that many of these systems are expensive to maintain because they are so high-tech.
The recommendation we made is that most GIS systems should be replaced with GRASS GIS systems. GRASS GIS (Geographic Resources Analysis Support System) is a free, open source geographical information system (GIS) capable of handling raster, topological vector, image processing, and graphic data. GRASS GIS systems is beneficial to many health professionals because it can be used on multiple platforms which include Mac OS X, Microsoft Windows and Linux. The History of GRASS has been continuing since 1982 and has involved a great deal of federal US agencies, universities, and private corporations. Continually developing, GRASS has evolved into a powerful software suite with a wide range of applications and is currently being used in academic and commercial settings around the world. Many government agencies including NASA and the U.S. Census Bureau use GRASS as well. Stressed, GRASS is a reliable program that is free and openly accessible.
We suggest that all of North American governments and cities utilize this GRASS system because it is free and have many benefits. Health professionals don’t have to worry about having to purchase expensive systems that do the same things that GRASS offers. Another advantage of GRASS is that it is specially designed as an environment in which tools that perform specific computations. Unlike other GIS softwares, the user is presented with a UNIX shell containing a modified environment that supports GRASS commands (GRASS GIS). The environment has a state that includes such parameters as the geographic region covered and the map projection in use. All GRASS modules read this state and are given specific parameters (such as input and output maps, or values to use in a computation) when executed. The majority of GRASS modules and capabilities can be operated through a graphical user interface as an alternative to manipulating geographic data in shell (GRASS GIS).
GRASS GIS systems are used in many U.S regions, but our concern is that it should be utilized all across North America, so all health professionals and EMS has the best and most efficient technologies to use. There are over 200 GRASS modules and 100 add-on modules created by users and are all offered in the GRASS website (GRASS GIS).
Works Cited
Boulous, Maged N Kamel. "Towards Evidence-Based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom." International Journal of Health Geographics (2004): 47.
MPower Webcast - Robust, Easy to Use GIS for Governments - April 7th." MPower Innovations Latest News. 30 Mar. 2009 <http://www.mpowerinnovations.com/events/56-mpower-innovations-webcast-robust-easy-to-use-gis-for-governments-march-25th-.html>.
The following should be included in the Group Project Final Report:
DANS SLIDES:
Strengths:
- GIS systems (geographical information systems) are systematic software that captures, analyzes, and manages data according to specific locations. GIS systems thus have the tools, which allow users to generate and analyze ‘spatial’ information, edit data and maps, and thereby present the results. Specifically, when relating these tools to ambulances and other such emergency uses, it provides advantages. Emergency planners can utilize these tools to calculate quick response times in the event of natural disasters and other emergency events.
- Why use GIS? Its simple, GIS systems can rearrange and integrate data with a spatial component meaning that with the information provided, a visual will be there to support the provided data. “For example, it is possible for you to combine the location of the Ambulance in relation to people’s homes, located by the address derived from the databases. GIS systems map this data, giving the emergency dispatchers a visual tool to plan the best routes for emergency mobiles. This ultimately saves time and lives.”
Weaknesses:
- Geographers have recognized since long time ago, that location-specific attributes were vital and they influence the incidence. Geographers have notified that time and space are critical to the human condition, but why has public health taken so long to do the same? With the introduction of GIS, it is revolutionizing geography and they have the same potential within public health. The potential of these systems effectively puts into the hands of epidemiologists and prevention specialists the power to understand and manipulate space and place (Harries and Daub). However the consequence of this is that the public health professionals must learn to “think” geographically. As much as it sounds easy, this knowledge is not easily acquired.
- EMS has shifted from its traditional role of emergency transport and inter-facility transfers for emergency and non-urgent circumstances. Due to “concentrating expensive surgical/trauma and other specialty procedures in large urban or regional hospitals, the ‘aging’ of Canada’s population, the shortage of rural physicians, and the reality that few family physicians provide evening and weekend medical care for their patients,” (EMS Cheifs of Canada) EMS is further more important to Canadian residents. With these trends, Canadians further rely on EMS’s health care delivery.
Recommendations: Weakness
- GIS systems are an important tool for health professionals because it acts as a window into the world of geography. These systems capture and present data and displays geographic information, which ranges from spatial information and it also provides where incidents are occurring. By ensuring that health professionals are fully trained to operate GIS systems and to present it, it enables them to send out routes and locations as fast as possible and as efficiently as possible. All health care centres and health professionals should fully train their GIS operators with all required knowledge and everything that needs to be learned so that they do not run into any dilemmas when an emergency arises.
- Some of the risks that come up to mind are that these GIS manufacturers might charge a great deal in teaching courses for health professionals. This might result in health professionals just to negate the process of learning from “professionals” and trying to learn how to operate the GIS systems themselves.
- GIS systems range in its capabilities and its costs. Some GIS systems are available at no costs, and some are very expensive. Some of the GIS softwares cost hundreds and thousands of dollars and are difficult to use. Basic spatial analysis programs can cost between $200 to $2000 (Harries and Daub). GIS systems are vital tools to save lives and assist in emergencies that occur. However, it is reasonable that many of these systems are expensive to maintain because they are so high-tech.
- GRASS GIS (Geographic Resources Analysis Support System) is a free, open source geographical information system (GIS) capable of handling raster, topological vector, image processing, and graphic data. GRASS GIS systems is beneficial to many health professionals because it can be used on multiple platforms which include Mac OS X, Microsoft Windows and Linux.
We suggest that all of North American governments and cities utilize this GRASS system because it is free and have many benefits. Health professionals don’t have to worry about having to purchase expensive systems that do the same things that GRASS offers. Another advantage of GRASS is that it is specially designed as an environment in which tools that perform specific computations. Unlike other GIS softwares, the user is presented with a UNIX shell containing a modified environment that supports GRASS commands (GRASS GIS
For opportunities and threats and two recommendations pertaining to them, please see
- Lorianne
Presentation Slides, please see
Part Two – SWOT Analysis
Strengths:
GIS systems (geographical information systems) are systematic software that captures, analyzes, and manages data according to specific locations. GIS systems thus have the tools, which allow users to generate and analyze ‘spatial’ information, edit data and maps, and thereby present the results. Specifically, when relating these tools to ambulances and other such emergency uses, it provides advantages. Emergency planners can utilize these tools to calculate quick response times in the event of natural disasters and other emergency events.
This SWOT analysis will focus on GIS systems related with Ambulances and other emergency events. The reason that GIS systems prove to be so meaningful and useful for ‘Emergency ambulances’ are because the information at hand can be constantly accessed, transferred, rearranged, processed, and displayed using numerous applications. Emergency uses in Canada often use custom soft wares such as “GRASS” which is a more specialized product that is more efficient advanced. (What is Grass? Geographic Resources Analysis Support System, commonly referred to as GRASS GIS, is a Geographic Information System (GIS) used for data management, image processing, graphics production, spatial modeling, and visualization of many types of data. It is Free (Libre) Software/Open Source released under GNU General Public License (GPL)) (Grass GIS).
GIS data previously was based on gigantic computers to maintain data and records (limited soft wares). Technology progressed and the increase of internet access grew the demand for GIS. Geographical features are expressed as vector images and different types of geometry, which are by points-lines-and polygons, represent these features.
Why use GIS? Its simple, GIS systems can rearrange and integrate data with a spatial component meaning that with the information provided, a visual will be there to support the provided data. “For example, it is possible for you to combine the location of the Ambulance in relation to people’s homes, located by the address derived from the databases. GIS systems map this data, giving the emergency dispatchers a visual tool to plan the best routes for emergency mobiles. This ultimately saves time and lives.” (Why Use Gis).
Relating GIS systems used in Emergency vehicles can be related to the study of Business Intelligence in Lecture 3 of Class 225. Business Intelligence is the knowledge about your customers, competitors, business partners, competitors, and internal operations (Evans). GIS systems in ambulances would correlate with BI Systems because it is an IT application that supports the business intelligence function from within. The objective of BI systems is to improve timeliness and quality for decision-making (Evans). Utilizing GIS systems allow users to generate and analyze ‘spatial’ information, edit data and maps, and thereby present the results. Specifically, when relating these tools to ambulances and other such emergency uses, it provides advantages. Emergency planners can utilize these tools to calculate quick response times in the event of natural disasters and other emergency events. Therefore, Emergency planners will have direct advantage in a case of crisis over anyone else.
Weaknesses:
When thinking of GIS systems, people might think that it is a wonderful piece of technology; and it is. However there are some downfalls to this specially designed software. In the early days, when any kind of epidemic broke out, there was no available therapy, or mode of quick transportation or any responsible agent (EMS). Location was key and the environments around the location.
Geographers have recognized since long time ago, that location-specific attributes were vital and they influence the incidence. Geographers have notified that time and space are critical to the human condition, but why has public health taken so long to do the same? With the introduction of GIS, it is revolutionizing geography and they have the same potential within public health. The potential of these systems effectively puts into the hands of epidemiologists and prevention specialists the power to understand and manipulate space and place (Harries and Daub). However the consequence of this is that the public health professionals must learn to “think” geographically. As much as it sounds easy, this knowledge is not easily acquired.
There are some concerns with geography; the characterization of places, understanding of man to land relationships, accounting for spatial distributions, and the differentiation of areas and the formation of regions (Harries and Daub). Geographic analyses have one of two aims which are; to account for spatial variation and to integrate all of the variation at a location so as to explain or characterize a place or region.
GIS is an important tool for health professionals because it acts as an access window into world of geography. However, GIS software ranges in its costs and capabilities. Some programs have been available at no cost, where as some of the other GIS softwares cost hundreds and thousands of dollars and are difficult to use. Basic spatial analysis programs can cost between $200 to $2000 (Harries and Daub)..
Other then the fact that maintaining GIS systems are expensive; there are three required elements for the applications of GIS to public health. The first element is that a specific GIS software program must be acquired. These programs are available in most of the Asian countries and European countries. The second element is that computer readable files must be acquired. These readable files are similar to hard copy maps showing various jurisdictional boundaries. Boundary files are unique to the GIS’s study area (Harries and Daub). For instance, in the US, one might acquire files for zip-codes and state boundaries; In England, they have their own postal zones. So in a general sense, the boundary files must be digitally compatible with the specific GIS software product. Finally, the third element requires that the GIS systems obtain geographically referenced attribute data; which is all the data pertaining to the demographics, population and "cases" to be mapped (Harries and Daub).
Opportunities
In examining the opportunities of the EMS system, we can look at it from a political, economical, environmental, social, and technological perspective. Technologically speaking, greater technological advances lead to higher efficiency. Higher efficiency includes a shorter route for emergency services, this could save staff and patient time and gas. Saved time and gas provide for a more economical environment. Socially speaking, better health care means higher social responsibility for the greater population. The opportunities listed are just examples of the benefits EMS creates. Further more opportunities are explored below.
Hospitals today are not only judged by indicators of patients’ health and recovery. “The modern hospital is a socio-technical organization.” (Dave 238) Aside from the end result, hospitals are also being judged and criticized for the process and delivery of health care. Since the GIS system has proven to increase response times and bring patients to the nearest hospital on the fastest route, it is safe to say that the quality of service delivery has improved. Thus, if a quality assurance analysis were to be made for EMS Emergency Ambulance or for the general health care system, the quality has improved in terms of service delivery for customer care.
Due to the sophistication of GIS, not only is the EMS prepared to get to point A to point B, surveillance of disease-prone communities can now be implemented. “Medical surveillance (or biosurveillance) systems look at the health and disease status of a population.” (Busko) The GIS will be able to detect and flag existing clusters of diseases and symptoms in any certain area. If the clusters are happening more than expected, safety measures can be taken into account. The technology of GIS is able to go beyond our daily health care emergency delivery by surveying the whole community for dangers.
Since GIS systems utilize spatial data, it is environmental friendly. Unlike activities that require natural resources, GIS systems use spatial data. And unlike other resources, “spatial data do not suffer any wear and tear from repeated use.” (Boulous)
In contrast, repeated use of spatial data would benefit the staff (or user). Increased use would increase the possibilities for improving the quality of spatial data and collections. The more we learn how to use the system and the more feedback we provide for GIS creators, the higher the future quality of it. With the use of spatial data, we do not have to worry about consuming the environment’s limited resources. Instead, we can happily go about using spatial data because we know it may be a good cause for the future creations of GIS.
EMS has shifted from its traditional role of emergency transport and inter-facility transfers for emergency and non-urgent circumstances. Due to “concentrating expensive surgical/trauma and other specialty procedures in large urban or regional hospitals, the ‘aging’ of Canada’s population, the shortage of rural physicians, and the reality that few family physicians provide evening and weekend medical care for their patients,” (EMS Cheifs of Canada) EMS is further more important to Canadian residents. With these trends, Canadians further rely on EMS’s health care delivery. The reliance provides a sense of security and safety to those in need. With increased importance to the community, EMS goes beyond its traditional role of health delivery. For example, Long and Brier Islands of Nova Scotia “lack immediate access to doctors and nurses, so EMS has assumed non-traditional roles in the realm of primary health care, such as administering flu vaccinations on the islands.” With ever more importance to society, EMS is pursuing in a role expansion to support Canada’s increased health demands.
Threats
Emergency care and access should be well informed to the public. It is the EMS’s duty to educate the public. “Efforts at education are directed towards the importance of calling for help early.” (Dave 247) Although response and put times are more efficent with the GIS, it should be made clear that calling for help early is vital. In the United States, a “911 Telephone Triage System is in place.” (Dave 247) In addition to highlighting the importance of calling EMS early, CPR and BLS should also be taught to the community. To prevent accident injuries and fatalities, the use of seatbelts in vehicles should be mandatory, drinking and driving should be prohibited, car seat placement should be directed for children, and the use of airbag and child safety should be implemented. It is up to the EMS to educate its citizens, but it is up to the citizens to learn and follow rules, regulations, and precautions. To further increase efficient use of EMS, a curriculum and local education is needed.
Since GIS utilizes the maps and images derived from satellitie systems, there is the question of privacy and censorship. The access GIS has intervenes and involves with everyone’s personal environment. “A number of these studies using the networking capabilities of GIS have been concerned with the concept of potential accessibility. Others, who have had access to spatially disaggregated data, have been concerned with (actual) revealed accessibility patterns of service utilization.” (Boulous) It is debatable whether this is ethical or not. Does efficiency equal less privacy? A public consent may be the solution to problems with privacy and censorship.
Although surveillance systems can detect disease and symptom clusters in communities, it is not fool-proof. “Surveillance systems must look for ‘important’ disease or syndromes and be able to detect changes from the baseline.” (Busko) For example, SARS symptoms may be detected as flu symptoms. The symptoms and diseases need to be clearly distinctive in severity and morality of other diseases in order for the surveilannce to identify it correctly. Therefore, false and ambiguous assumptions may be made about the detected diseases.
Federal funding and financial sponsors for health care systems have been restricted and the shaky economy does not make any positive promises for the future health care budget. “In an era of governmental fiscal restraint it is likely that federal funding for EMS activities will continue to decrease.” (NHTSA) This jeopardizes the availability of GIS across all provinces and states. When there is not enough financial resources, will the government restrict the areas where GIS will be implemented? It may not be fair to all citizens if there is not equal access to EMS technologies.
Federal funding has decreased and financial sponsors for health care systems have been restricted but yet, Canada is facing higher demands in the health sector as the senior population soars rapidly. EMS and paramedics focus on providing life support and emergency care to stabilize patients’ conditions as they rush to the nearest hospital. Demands for EMS services are anticipating a high demand because of demographic trends, such as a rapidly increasing senior population “Canada faces significant aging of its population as the proportion of seniors increase more rapidly than all other age groups. In 2001, one Canadian in eight was aged 65 years or over. By 2026, one Canadian in five will have reached age 65.” (Health Canada) With an increased demand and lowered funds, EMS needs to find a solution somehow to meet the community’s needs.
Health care delivery for EMS goes beyond simple automobile deliveries, EMS also employs the use of helicopters, satellites, and GIS. In saving the lives of patients, EMS staff also put themselves in danger on the road and in the air. “Dr. Ira Blumen, program and medical director of the University of Chicago Aeromedical Network, noted that the rate of fatalities per 100,000 air-ambulance employees over the past 10 years exceeds those of other dangerous professions such as deep-sea fishing or logging.” (EMS Daily News) It has become a concern that EMS staff and emergency patients’ lives are in danger while ironically striving for the opposite; saving lives. The irony brings us to wonder about the safety precautions that should be taken into account. Rules and regulations should be implemented to ensure the safety of the general public, including those of paramedics and EMTS. Saving lives should not cross lines with risking lives.
Recommendations
Threat: Keeping the public informed.
According to the first threat listed, the supporting informed public is important in order for an EMS system to be effective. The EMS organization needs the support of the public that they are serving. To develop this relationship between the two, EMS needs to reach out to its citizens and communities venues such as neighbourhood associations, service groups, and participating citizens. It is a valuable relationship that will benefit the EMS organization’s reputation but more importantly, it will keep citizens well informed and supportive of what EMS provides and accommodates.
Reaching out to citizens may come in all sorts and forms. One way of public education is starting with children. Children are the ones who are more open and willing to learn. EMS staff and representatives may consider visiting schools with pamphlets, presentations, and activities that bring enthusiasm to the children. As an example, Canada’s fire and safety department utilize a mascot called, Elmer the Safety Elephant, to attract children. Elmer teaches the children to “stop, drop, and roll” when they catch on to fire. “The role of Elmer the Safety Elephant is to teach young children how to stay safe. From the day he first appeared over 50 years ago, he was an instant hit with kids. Over the years, his image has changed to maintain his positive impact on young children.” (Canada Safety Council) Elmer the elephant has been around for 50 years now and continues to be an asset of informing children all over the nation. Elmer’s 50 years of existence proves that it has been a success and the EMS organization should consider employing a similar strategy of education.
To educate the public children of EMS services, EMS may send representatives and staff to schools annually. A roadblock to this form of education may be acquiring the permission of school administrators and parents. A formal proposal will be needed to show the importance of safety acknowledgement. Since similar programs like Elmer the Safety Elephant has been implemented before, consent for another mascot should not be difficult. Although this may require time and extra-curricular costs for the organization, the expected result is worthy.
Thorough and interesting information must be communicated to the public. If information is not thorough, the whole process will fail to inform. If the information is not interesting, children will not engrave the information in their heads. Staff and representatives of EMS can share personal stories. Games and activities may be pursued in for children to get involved with the learning process. Following the examples of Elmer, the Elmer site provides children with coloring pages that can be printed out, activities, games, and quizzes. (Canada Safety Council) Therefore, a well thought-out educating process is required in order for it to be effective and useful.
The education of EMS’s services will provide a support and knowledge foundation for its services. A developed relationship with the community establishes a foundation of support that may come in handy when attempting to create new EMS stations, routing emergency response paths, or gathering additional funds for the future. A positive reputation is beneficial to the EMS for such factors but most importantly, educating the public for their own safety is vital. A well informed public will further increase medical efficiency, decrease respone times, and keep citizens secure. A curriculum and local education will create a more informed community.
Threat: The fatal accidents and injuries of EMS helicopters
The goal for EMS staff is to help stabilize the situation of patients while transferring them to further professional help in hospitals in the shortest time frame possible. Advanced technology using satellites and GIS have enabled decreased response times and higher survival rates. However, these increased survival rates may only apply to the patients. “In January 2006, the NTSB issued a Special Investigation Report on EMS operations that involved the analysis of all EMS-related aviation accidents that occurred from January 2002 through January 2005. There were 55 accidents during this three-year window; they involved 41 helicopters and 14 airplanes, and killed 54 people and seriously injured 19.” (EMS Daily News) Planes and helicopters have been lost, lives have been taken away, and staff and patients have been hurt through the process of life-saving.
The irony of these accidents have been brought to the attention of the general public. Accidents occur but prevention and precautions help keep accident numbers to a minimal. “The Board concluded that 29 of the 55 accidents could have been prevented with corrective actions identified in the report.” (EMS Daily News) It is unfortunate that the lost lives could have been saved. It should be recommended that EMS operators follow a certain set of guidelines, rules, and regulations for patients’ safety, as well as their own. In response to these accidents, recommendations have been made already but there has yet to be legal rules made by policy makers.
If regulations and rules are followed, EMS staff would be able to conduct emergency deliveries in a more safely manner and arrive at the hospital “flawless.” “It recommended that the FAA require all EMS operators to comply with Part 135 operations specifications during the conduct of all flights with medical personnel on board; mandate that all EMS operators develop and implement flight risk evaluation programs; require EMS operators to use formalized dispatch and flight-following procedures that include up-to-date weather information and assistance in flight risk assessment decisions; and require EMS operators to install terrain awareness and warning systems (TAWS) on their aircraft.” (EMS Daily News) Further training should be required for EMS personnel. This may create more costs but will result in future benefits. Less planes and helicopters would be lost, more lives will be saved.
In addition to formulating legal rules and precautions to be taken into account, air ambulances should also streamline their patient acceptances. A typical flight at work usually involves a helicopter or plane and crewmembers who are paramedics and pilots. Also, “air-ambulance flights spend more time flying without patients than with them.” (EMS Daily News) Weighing out the costs and benefits, it seems almost unworthy to fork out so many risks and monetary costs for minor injuries. Canada’s paramedic training system, Ornge, faced a high number of accidents in injuries previously but has now gained international recognition. Ornge used the strategy of streamlining, which allowed them “to treat the entire province like a busy emergency room, where the sickest patients – whether an elderly woman who needs emergency heart surgery, or a 3-year-old whose face was slashed in a lawn mower accident – are transported first.” (Ogilvie) Streamlining forces EMS air ambulances to do only what’s crucial.
To streamline would mean to cut back on the transportation of non-urgent patients. The cost of this is a health care system that overlooks certain patients. Although this may put air-ambulances in a bad light, streamlining is actually saving lives by taking safety precautions. Therefore, streamlining should be implemented to take out the irony of what EMS strives for.
DANS RECOMMENDATIONS IN WORD:
Weakness: Health Professionals Must be Aware of How to use GIS systems
The first weakness I have decided to target is that even though the potential of these systems effectively are in the hands of epidemiologists and prevention specialists the power to understand and manipulate space and place (Harries and Daub), the consequence of this is that the public health professionals must learn to “think” geographically. As much as it sounds easy, this knowledge is not easily acquired. This means that health professionals must know everything in terms of geography; they must be familiar with the characterization of places, understanding of man to land relationships, accounting for spatial distributions, and the differentiation of areas and the formation of regions.
The reason why we targeted this weakness is because it is critical for health professionals to be able to use and utilize GIS systems to ensure fast and efficient routes and times when sending out EMS (Emergency Medical Services) and EMV’s (Emergency Medical Vehicles). GIS systems are an important tool for health professionals because it acts as a window into the world of geography. These systems capture and present data and displays geographic information, which ranges from spatial information and it also provides where incidents are occurring. By ensuring that health professionals are fully trained to operate GIS systems and to present it, it enables them to send out routes and locations as fast as possible and as efficiently as possible. All health care centres and health professionals should fully train their GIS operators with all required knowledge and everything that needs to be learned so that they do not run into any dilemmas when an emergency arises.
mPower Innovations have decided to create GIS systems for American governments which are made easy and easily affordable. Many city governments are leaning towards mPower and are taking control of their mapping applications and data (mPower Webcast). This company offers webcast presentations on certain days and allow people to register and attend these events to learn and how to use their softwares. If all of the GIS manufacturers were to use this technique in the world and teach health professionals and EMS operators, they would be able to think geographically and attend to emergencies most efficiently.
Some of the risks that come up to mind are that these GIS manufacturers might charge a great deal in teaching courses for health professionals. This might result in health professionals just to negate the process of learning from “professionals” and trying to learn how to operate the GIS systems themselves. The recommendation chosen has been incorporated before as mentioned above. mPower Innovations offer webcast presentations but we are unsure if they offer open classes or private classes that cost money.
Weakness: Using GRASS GIS systems which are Cheap and Useful
The second recommendation will also be based on another weakness. GIS systems range in its capabilities and its costs. Some GIS systems are available at no costs, and some are very expensive. Some of the GIS softwares cost hundreds and thousands of dollars and are difficult to use. Basic spatial analysis programs can cost between $200 to $2000 (Harries and Daub). GIS systems are vital tools to save lives and assist in emergencies that occur. However, it is reasonable that many of these systems are expensive to maintain because they are so high-tech.
The recommendation we made is that most GIS systems should be replaced with GRASS GIS systems. GRASS GIS (Geographic Resources Analysis Support System) is a free, open source geographical information system (GIS) capable of handling raster, topological vector, image processing, and graphic data. GRASS GIS systems is beneficial to many health professionals because it can be used on multiple platforms which include Mac OS X, Microsoft Windows and Linux. The History of GRASS has been continuing since 1982 and has involved a great deal of federal US agencies, universities, and private corporations. Continually developing, GRASS has evolved into a powerful software suite with a wide range of applications and is currently being used in academic and commercial settings around the world. Many government agencies including NASA and the U.S. Census Bureau use GRASS as well. Stressed, GRASS is a reliable program that is free and openly accessible.
We suggest that all of North American governments and cities utilize this GRASS system because it is free and have many benefits. Health professionals don’t have to worry about having to purchase expensive systems that do the same things that GRASS offers. Another advantage of GRASS is that it is specially designed as an environment in which tools that perform specific computations. Unlike other GIS softwares, the user is presented with a UNIX shell containing a modified environment that supports GRASS commands (GRASS GIS). The environment has a state that includes such parameters as the geographic region covered and the map projection in use. All GRASS modules read this state and are given specific parameters (such as input and output maps, or values to use in a computation) when executed. The majority of GRASS modules and capabilities can be operated through a graphical user interface as an alternative to manipulating geographic data in shell (GRASS GIS).
GRASS GIS systems are used in many U.S regions, but our concern is that it should be utilized all across North America, so all health professionals and EMS has the best and most efficient technologies to use. There are over 200 GRASS modules and 100 add-on modules created by users and are all offered in the GRASS website (GRASS GIS).
Works Cited
Boulous, Maged N Kamel. "Towards Evidence-Based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom." International Journal of Health Geographics (2004): 47.Busko, Jonathan. "EMS Responder." 8 July 2008. EMS and Medical Surveillance. 3 February 2008 <http://www.emsresponder.com/print/Emergency--Medical-Services/EMS-and-Medical-Surveillance/1$4848>.
Evans, Max. "CCT 225: Information Systems." Lecture 3. University of Ontario, Mississauga. 19 Jan. 2009.
Canada Safety Council. Home of Elmer the Safety Element. 2008. 17 March 2009 <http://www.elmer.ca/about-elmer.php>.
EMS Cheifs of Canada. The Futre of EMS in Canada: Defining the New Road Ahead. EMSCC/DSMUC 2006. Calgary, 2006.
EMS Daily News. EMS Daily News. March 2009. 20 March 2009 <http://www.emsdailynews.com/archives/tag/air-ambulancehelicopter>.
Dave, P.K. Emergency Medical Services and Disaster Management. Alpha Science Int'l Ltd., 2003.
"General Information." GRASS GIS. Ed. Development Team. 12 Apr. 2008. Grass Development. 9 Feb. 2009 <http://grass.itc.it/intro/general.php>.
NHTSA. "Emergency Medical Services." 2006. Agenda for the Future. 1 February 2008 <http://www.nhtsa.dot.gov/people/injury/ems/agenda/emsman.html>.
"Why Use GIS?" The Guide to Geographic Information Systems. GIS. 9 Feb. 2009 <http://www.gis.com/whatisgis/whyusegis.html>.
Health Canada. Canada's Aging Population. Government. Ottawa: Minister of Public Works and Government Services 2002, 2002.
Ogilvie, Megan. "How Ontario rescued its Air Ambulances." 28 March 2009. The Toronto Star. 28 March 2009 <http://www.thestar.com/article/609875>.
MPower Webcast - Robust, Easy to Use GIS for Governments - April 7th." MPower Innovations Latest News. 30 Mar. 2009 <http://www.mpowerinnovations.com/events/56-mpower-innovations-webcast-robust-easy-to-use-gis-for-governments-march-25th-.html>.
GRASS GIS - The World Leading Free Software GIS. 30 Mar. 2009 <http://grass.osgeo.org/>.
Sources:
Harries, Keith D., and Erich M. Daub. Centers for Disease Control and Prevention. 30 Mar. 2009 <http://www.cdc.gov/nchs/data/ice/ice95v1/c36.pdf>.